Showing papers in "Surgical Laparoscopy Endoscopy & Percutaneous Techniques in 2013"
TL;DR: Male sex, age above 75 years old, and ASA 3 and 4 were identified as independent predictors of negative compliance to most of the postoperative FT items.
Abstract: The aim of this prospective cohort study was to identify the patient factors that predict postoperative deviation from each item of a fast-track colorectal surgery protocol (FT) and these factors' influences on postoperative outcomes. A total of 606 patients with colorectal pathology from 2005 to 2011 were analyzed to assess the relationships between patient factors, the outcome variables, and the items of the FT program. The median length of stay was 5 days, and readmission rate was 2.3%. The morbidity rate was 26.7%. Independent predictors of prolonged length of stay were older than 75 years of age, ASA grade 3 and 4, and the presence of an ileostomy. Independent predictors of morbidity were age above 75 years old and ASA grade, whereas age was confirmed as an independent predictor of mortality. Male sex, age above 75 years old, and ASA 3 and 4 were identified as independent predictors of negative compliance to most of the postoperative FT items.
70 citations
TL;DR: The 3D imaging systems may cause a significant reduction in the performance time of laparoscopic cholecystectomy.
Abstract: Objective:The aim of this study is to evaluate the effect of the Viking 3-dimensional (3D) system on performance time of laparoscopic cholecystectomy.Methods:Twenty-two patients were included in the study. The groups were standardized using a multiparameters filter (MPF) depending on preoperative ul
68 citations
TL;DR: Either SLA or SILA offer patients faster recovery period with acceptable complications than OA, and laparoscopic approach might be considered as first option in the treatment of AA.
Abstract: BACKGROUND This prospective randomized study aimed to evaluate the surgical outcomes of single-incision laparoscopic appendectomy (SILA) comparing with open appendectomy (OA) and standard 3-port laparoscopic appendectomy (SLA) in the treatment of acute appendicitis (AA). METHODS Adult patients older than 18 years presenting with AA were randomized into 3 groups to undergo OA, SLA, and SILA from September 2010 to May 2011. The groups were compared with regard of patient's characteristics, perioperative findings/complications, operative time, pain severity, analgesic requirement, time to oral tolerance and flatus, length of hospital stay, and cosmetic results. RESULTS A total of 75 consecutive patients enrolled in the study. Each group included 25 patients. The groups showed no significant differences in patient's characteristics. The mean operative time was significantly longer in SILA than OA with a mean difference of 7 minutes (P < 0.05). Postoperative pain after OA were significantly higher than SLA and SILA (P < 0.05). The average time to oral tolerance and flatus was significantly higher in OA than the laparoscopic groups with a mean difference of 1 and 2.5 hours (P = 0.04 and 0.023, respectively). The length of hospital stay in SLA and SILA was significantly lower than OA with a mean difference of 0.8 days (P < 0.05). There was no difference in overall complications between the groups. There was no difference between SLA and SILA in terms of surgical outcomes. CONCLUSIONS Either SLA or SILA offer patients faster recovery period with acceptable complications than OA. Hence, laparoscopic approach might be considered as first option in the treatment of AA. However, all 3 techniques provide equivalent clinical outcomes despite the significant findings. Therefore, technique selection is based on surgeon's decision, experience, and availability of laparoscopic instruments.
57 citations
TL;DR: Although open distal gastrectomy may be associated with shorter operative time, patients undergoing laparoscopic approach may be benefitted from a shorter hospital stay and a faster resumption without translation into an increase in both postoperative morbidity and mortality.
Abstract: Background:Laparoscopy-assisted distal gastrectomy (LADG) is one of the most accepted laparoscopic procedures in the field of gastric surgery. However, currently this procedure for the advanced gastric cancer (AGC) has still not reached the area of the popularization. The aim of this study was to co
54 citations
TL;DR: Efforts to reduce the objective recurrence rate after laparoscopic PEH repair should focus on minimizing tension with the use of a Collis gastroplasty and crural relaxing incisions when necessary.
Abstract: Introduction:Laparoscopic repair of paraesophageal hernias (PEH) is associated with a high objective hernia recurrence rate. Tension is a key factor in the repair of any hernia, and tension is a cause for hernia recurrence.Methods:This is a review of my current technique for PEH repair, and represen
49 citations
TL;DR: Higher age and elevated CRP level are independent predictors for conversion in early laparoscopic cholecystectomy in patients with age >65 years and/orCRP level >165 mg/L should be considered as high risk for conversion.
Abstract: Introduction:The aim was to enable prediction of risk for conversion in early laparoscopic cholecystectomy for acute cholecystitis.Methods:Multivariate analysis and receiver operating characteristic curve analysis were used to define independent predictors for conversion and optimal cutoffs. Using t
45 citations
TL;DR: In the authors' opinion, closure of the appendix stump with polymeric nonabsorbable clips in laparoscopic appendectomy may be a cheaper and simpler alternative to other widely used methods.
Abstract: The aim of this prospective randomized trial was to evaluate the clinical outcomes of hem-o-lok ligation system in laparoscopic appendix stump closure by comparing the endoloop ligature. A total of 53 patients were evaluated in this study (n=26 and 27 for hem-o-lok and endoloop groups, respectively). The mean operation time were shorter in hem-o-lok group than endoloop group (64.7 ± 19.2 vs. 75.4 ± 23, respectively); however, the difference was not significant. Other surgical findings were similar. There was no statistically significant difference in overall nonsurgically or surgically related complications. The mean postoperative hospitalization time was also similar in both groups. Although it is not possible to make general conclusions on basis of such a limited study, in our opinion, closure of the appendix stump with polymeric nonabsorbable clips in laparoscopic appendectomy may be a cheaper and simpler alternative to other widely used methods.
45 citations
TL;DR: The results of the present meta-analysis might be helpful to design future high-powered randomized studies that compare MIN with ON for acute necrotizing pancreatitis and to draw a definitive conclusion on this topic.
Abstract: AIM The purpose of this meta-analysis and systematic review is to compare minimally invasive necrosectomy (MIN) versus open necrosectomy (ON) surgery for infected necrosis of acute pancreatitis. METHODS One randomized controlled trial and 3 clinical controlled trials were selected, with a total of 336 patients (215 patients who underwent MIN and 121 patients underwent ON) included after searching in the following databases: Medline, Embase, Cochrane Central Register of Controlled Trials, BioMed Central, Science Citation Index (from inception to August 2011), Greynet, SIGLE (System for Information on Grey Literature in Europe), National Technological Information Service, British Library Integrated catalogue, and the Current Controlled Trials. Statistical analysis is performed using the odds ratio (OR) and weighted mean difference with 95% confidence interval (CI). RESULTS After the analysis of the data amenable to polling, significant advantages were found in favor of the MIN in terms of: incidence of multiple organ failure (OR, 0.16; 95% CI, 0.06-0.39) (P < 0.0001), incisional hernias (OR, 0.23; 95% CI, 0.06-0.90) (P = 0.03), new-onset diabetes (OR, 0.32; 95% CI, 0.12-0.88) (P = 0.03), and for the use of pancreatic enzymes (OR, 0.005; 95% CI, 0.04-0.57) (P = 0.005). No differences were found in terms of mortality rate (OR, 0.43; 95% CI, 0.18-1.05) (P = 0.06), multiple systemic complications (OR, 0.34; 95% CI, 0.01-8.60) (P = 0.51), surgical reintervention for further necrosectomy (OR, 0.16; 95% CI, 0.00-3.07) (P = 0.19), intra-abdominal bleeding (OR, 0.79; 95% CI, 0.41-1.50) (P = 0.46), enterocutaneous fistula or perforation of visceral organs (OR, 0.52; 95% CI, 0.27-1.00) (P = 0.05), pancreatic fistula (OR, 0.66; 95% CI, 0.30-1.46) (P = 0.30), and surgical reintervention for postoperative complications (OR, 0.50; 95% CI, 0.23-1.08) (P = 0.08). CONCLUSIONS The lack of comparative studies and high heterogeneity of the data present in the literature did not permit to draw a definitive conclusion on this topic. The results of the present meta-analysis might be helpful to design future high-powered randomized studies that compare MIN with ON for acute necrotizing pancreatitis.
43 citations
TL;DR: The present evidence demonstrates that retroperitoneal adrenalectomy is better than trans peritoneal approach for patients with adrenal tumor in short-term outcomes, however, extended follow-ups and further randomized controlled trials should be required to analysis.
Abstract: BACKGROUND: The study aims to provide a pooled meta-analysis of existing studies that compare the outcomes of retroperitoneal laparoscopic adrenalectomy with transperitoneal approach for adrenal tumor. METHODS: A systematic search of electronic databases was performed and studies were selected based on specific inclusion and exclusion criteria. Data of interest were subjected to meta-analysis using randomized or fixed-effect model to calculate weight mean difference (WMD) or odds ratio (OR). The sensitivity analysis and publication bias test also be conducted. RESULTS: Nine observational studies with 632 patients were identified (339 retroperitoneal vs. 293 transperitoneal). Retroperitoneal approach was associated with shorter operative time [WMD=-13.10; 95% confidence interval (CI), -23.83 to -2.36; P=0.02], less intraoperative blood loss (WMD=-40.60; 95% CI, -79.73 to -1.47; P=0.04), shorter duration of hospital stay (WMD=-1.25; 95% CI, -2.36 to -0.14; P=0.03), or time to first ambulation (WMD=-0.38; 95% CI, -0.47 to -0.28; P<0.001). Although the difference between number of convert to open management, time to first oral intake, and major postoperative complication rate was not significant (OR=0.53; 95% CI, 0.17 to 1.60; P=0.26; WMD=-0.31; 95% CI, -1.14 to 0.52; P=0.47; OR=0.41; 95% CI, 0.06 to 1.06; P=0.07). CONCLUSIONS: The present evidence demonstrates that retroperitoneal adrenalectomy is better than transperitoneal approach for patients with adrenal tumor in short-term outcomes. However, extended follow-ups and further randomized controlled trials should be required to analysis.
40 citations
TL;DR: The method described in this study can be used to perform pancreaticoenteric anastomosis in the same manner as an open PD, while taking advantage of the merits of minimally invasive surgery.
Abstract: Purpose Pancreaticoduodenectomy (PD) is the treatment of choice for periampullary disease. Even with the increasing number of successful reports from around the globe, laparoscopic pancreaticoduodenectomy (LPD) is still not fully accepted. We report the results of our experience of LPD assisted by mini-laparotomy. Method This retrospective review study included 42 patients who received LPD assisted by mini-laparotomy between March 2009 and April 2012. Clinical outcomes, such as patient age, pathologic diagnosis, pancreas nature, operation time, conversion rate, hospital stay, postoperative complication, and mortality rates, were reviewed. Results A total of 42 patients (age range, 42 to 70 y ) received LPD assisted by mini-laparotomy. The mean incision length for the laparotomy was 5.2 cm. Mean operative time was 404 minutes, and 3 cases required conversion to open surgery. Mean postoperative hospital stay was 17 days. There were 3 cases of pancreaticogastrostomy leakage, 2 cases of postoperative bleeding, 4 cases of delayed gastric emptying, 1 case of bile leakage, and 5 cases of pulmonary complications. Of the 5 patients with pulmonary complications, 1 died. Conclusions When performed by a surgeon with ample experience in laparoscopic surgery, LPD assisted by mini-laparotomy is a safe, feasible alternative to conventional PD for select cases. The method described in this study can be used to perform pancreaticoenteric anastomosis in the same manner as an open PD, while taking advantage of the merits of minimally invasive surgery.
38 citations
TL;DR: Loop duodenojejunal bypass with sleeve gastrectomy is safe, feasible, and shows good efficacy in terms of glycemic control in this preliminary report with short follow-up.
Abstract: A total of 22 (14F/8M) patients with a mean age of 50.3 years (range, 33 to 64 y) and a mean body mass index of 28.4 kg/m2 (range, 21.8 to 38.3 kg/m2) underwent loop duodenojejunal bypass with sleeve gastrectomy from October 2011 to March 2012. The mean duration of onset of type 2 diabetes mellitus
TL;DR: Laroscopic central pancreatectomy is a feasible and useful technique for the removal of tumors located in the neck of the pancreas and should be promoted to promote its use.
Abstract: BACKGROUND: Central pancreatectomy is an alternative technique for benign or low-grade malignant tumors. Laparoscopic central pancreatectomy has been rarely performed, with only 48 cases reported in the English literature. The aim of this paper was to review all published cases together with 3 cases from our institution. METHODS: All published articles indexed on PubMed were included. Terms used were "laparoscopic central pancreatectomy" or "laparoscopic middle pancreatectomy." Variables studied were the operative time, the type of reconstruction, indications, the use of robotic or hand assistance, blood loss, transfusion, pancreatic fistula, hospital stay, follow-up, development of exocrine and/or endocrine insufficiency, morbidity, and mortality. RESULTS: A total of 51 patients were identified. Twenty-one patients underwent total laparoscopy (41.2%), 27 required robotic assistance (52.9%), one required hand assistance (1.9%), and there were 2 conversions. In 18 cases (35.3%), pancreatic reconstruction involved a Roux-en-Y pancreatojejunostomy, and in 32 cases, pancreatogastrostomy (62.7%). The mean operative time was 356 minutes. Blood loss was minimal in most cases, and only 1 patient required blood transfusion (1.9%). Mortality was nil, but morbidity was high, mainly because of pancreatic fistula (46%). The mean hospital stay was 13.8 days. All patients underwent laparoscopic central pancreatectomy for benign or low-grade neoplasms. The mean follow-up duration was 19.6 months (range, 2 to 48 mo). No patient presented exocrine or endocrine insufficiency. CONCLUSIONS: Laparoscopic central pancreatectomy is a feasible and useful technique for the removal of tumors located in the neck of the pancreas. There are very few centers performing this operation, and therefore, a literature review was necessary to identify its indications and technical possibilities, and to promote its use.
TL;DR: In this article, the feasibility and safety of non-posed endoscopic wall-inversion surgery for full-thickness resection of gastric malignancy was evaluated.
Abstract: Full-thickness resection for gastric malignancy carries a risk of peritoneal dissemination due to opening of the gastric lumen. We evaluated the feasibility and safety a novel method of full-thickness resection without transmural communication, called nonexposed endoscopic wall-inversion surgery in
TL;DR: SALC required longer operative times than CLC without significant benefits in patient overall satisfaction, postoperative pain, and hospital stay, and only satisfaction with the cosmetic result showed a significantly higher preference towards SALC.
Abstract: Background:Single-incision laparoscopic surgery has been proposed as a minimally invasive technique with the advantages of fewer scars and reduced pain. The aim of this study was to perform a systematic review and meta-analysis of prospective randomized clinical trials of single-access laparoscopic
TL;DR: This meta-analysis showed that LAP for gastric GISTs was associated with less blood loss, earlier return of bowel function, earlier resumption of diet, and shorter length of hospital stay when compared with OPEN; however, LAP and OPEN had similar operative time, overall complication, and recurrence.
Abstract: Purpose:We conducted a meta-analysis to compare surgical and oncologic outcomes of patients with gastric gastrointestinal stromal tumors (GISTs) undergoing laparoscopic resection surgery (LAP) and open resection surgery (OPEN).Methods:PubMed, Ovid, Web of Science, Cochrane, CNKI, and Chinese Biomedi
TL;DR: Good quality of resected specimens could be achieved with robotic LAR and further prospective studies including long-term oncologic outcomes and costs with higher patient number are definitely needed to assess the benefits of robotic resection in rectal cancer treatment.
Abstract: Background:Robotic surgery is thought to be a solution to overcome the limitations of laparoscopy in sphincter-saving resections. In this study, we present our results on patients undergoing robotic and laparoscopic low anterior resection (LAR) consecutively for rectal adenocarcinoma.Materials and M
TL;DR: Quicker recovery time, less pain, shorter hospital stay, and lower complication rate were observed in patients after laparoscopic surgery compared with patients after open surgery.
Abstract: The objective of our study was to assess the abilities and limitations of laparoscopy and evaluate its role in examination and treatment of patients with abdominal trauma. A total of 628 patients with blunt and penetrating abdominal trauma were included in this retrospective 12-year survey (2000 to 2011). All patients in the study underwent either laparotomy (280 patients) or urgent laparoscopy (348 patients). There was no difference in the demographic data and trauma severity between the 2 groups. Conversion to open surgery was performed in 130 cases (37.3%). Diagnostic laparoscopy without therapeutic manipulations was used in 160 patients (46%) and therapeutic laparoscopy was carried out in 58 patients (16.7%). Quicker recovery time, less pain, shorter hospital stay, and lower complication rate were observed in patients after laparoscopic surgery compared with patients after open surgery. No missed abdominal organs injuries were revealed after laparoscopic examination of abdominal cavity.
TL;DR: Low-volume PEG+Asc has comparable efficacy, safety, and tolerability as high-volumePEG+Sim; therefore, it can be considered as a good alternative solution for bowel preparation and more improvements are necessary to achieve the target of a perfect preparation.
Abstract: Background:The 2 L polyethylene glycol (PEG) lavage solution has been proved to be similarly safe and effective as 4 L PEG formulations, in spite of the reduced volume.Objective:To compare low-volume PEG-based solution combined with ascorbic acid with high-volume PEG-based solution combined with sim
TL;DR: It is concluded that laparoscopy offers a number of advantages over open interval appendectomy.
Abstract: This was a prospective randomized controlled study designed to compare laparoscopic and open interval appendectomy and involved 100 patients of appendicular phlegmon. After initial conservative management, patients were divided into 2 groups of 50 each and interval appendectomy was performed by lapa
TL;DR: The anatomic variety of the vessels in right-sided colon cancer is clarified using 3D-CT for understanding the anatomy to ensure a safe, precise operation.
Abstract: Background:The mesenteric vessels have many branching patterns. This study clarified the anatomic relationship between the superior mesenteric vein (SMV), the right colic artery (RCA), and the ileocolic artery (ICA) using 3-dimensional computed tomography (3D-CT). The relationship between the RCA an
TL;DR: A 3-port approach to LSG that was adopted in 750 consecutive cases was described and the LSG was completed with 4 cartridges in 712 cases (95%) and was associated with a 4.8% rate of complications including a 2.4% rates of leak.
Abstract: Laparoscopic sleeve gastrectomy (LSG) is considered a straightforward procedure but the surgical technique is one of the major determinants of the success of this procedure. We describe a 3-port approach to LSG that was adopted in 750 consecutive cases. The LSG was completed with 4 cartridges in 712 cases (95%) and was associated with a 4.8% rate of complications including a 2.4% rate of leak. The surgical technique is described in detail and the inherent advantages are discussed.
TL;DR: In conclusion, laparoscopic resection could achieve similar outcomes in terms of the incidence of VTE, which are associated with long-term benefits of the patients.
Abstract: The objective of this study was to systematically compare the incidence of postoperative venous thromboembolism (VTE; deep vein thrombosis and/or pulmonary embolism) in patients with colorectal cancer after laparoscopic surgery and conventional open surgery. A systematic search of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted. Eleven randomized control trials involving 3058 individuals who reported VTE outcomes were identified, of whom 1677 were treated with laparoscopic therapy and 1381 underwent open surgery. The combined results of the individual trials showed no statistically significant difference in the odds ratio for overall VTE (odds ratio 0.64, 95% confidence interval, 0.33-1.23, P=0.18), as well as in subgroups of deep vein thrombosis and anticoagulant prophylaxis between these 2 approaches. In conclusion, laparoscopic resection could achieve similar outcomes in terms of the incidence of VTE, which are associated with long-term benefits of the patients.
TL;DR: Percutaneous cholecystostomy can be performed safely in patients considered unfit for surgery at presentation and is similar in patients with or without gallstones, which means Hypotension and absence of common bile duct filling on initial cholangiography are markers of decreased long-term survival.
Abstract: Background Acute cholecystitis is a common surgical problem that is optimally managed by early laparoscopic cholecystectomy when possible. Percutaneous cholecystostomy (PC) has been used in certain high-risk cases as a bridge to surgery or for definitive therapy. The aim of this study was to determine the short-term and long-term outcomes of patients with acute cholecystitis treated by PC. Study design Patients with acute cholecystitis treated by PC between 2005 and 2011 in a tertiary hospital were identified from a prospectively maintained database. Outcome differences between patients with acalculous acute cholecystitis (AAC) and those with acute cholecystitis relating to gallstones were determined. Results There were 32 cases from a total of 443 patients with acute cholecystitis treated by PC during the study period. The overall 30-day mortality rate after PC was 9%. There were 8 patients with AAC in this series. Ischemic heart disease and chronic renal failure were noted in 47% and 41% of patients, respectively. In all cases, patients were considered unfit for surgery. AAC was more common in male patients. In all other aspects patients with AAC had similar characteristics to those with gallstones. Patients underwent percutaneous drainage a median of 3 days after admission with a direct transperitoneal route used in 16 (75%) cases. Positive bile cultures from the gallbladder were noted in 60% of cases tested. Complications were noted in 53% of patients and were related to the cholecystostomy tube in 19% of cases. Subsequent cholecystectomy was performed in 9 (28%) patients, at a median of 73 days after initial tube insertion. No differences in morbidity and mortality were noted between patients with AAC and those with gallstones. The overall mean and 12 months survival was 43 months and 72%, respectively. Hypotension at presentation (odds ratio 9.2; 95% confidence interval, 1.4-59.8; P=0.019) and absence of bile duct filling on cholecystography (odds ratio 4.6; 95% confidence interval, 1.2-16.3; P=0.017) were independently associated with decreased survival. Conclusions PC can be performed safely in patients considered unfit for surgery at presentation. Outcomes are similar in patients with or without gallstones. Hypotension and absence of common bile duct filling on initial cholangiography are markers of decreased long-term survival. A significant number of patients require subsequent definitive cholecystectomy.
TL;DR: Low-cost box models are a valuable tool alternative to virtual-reality simulators and should be developed by all surgical trainees during their training to achieve basic and advanced laparoscopic skills.
Abstract: Introduction:: Low-cost box models (BMs) are a valuable tool alternative to virtual-reality simulators. We aim to provide surgical trainees with a description of most common BMs and to present their validity to achieve basic and advanced laparoscopic skills. Materials and Methods:: A literature search was undertaken for all studies focusing on BMs, excluded were those presenting data on virtual-reality simulators only. Databases were screened up to December 2011. Results:: Numerous studies focused on various BMs to improve generic tasks (ie, instrument navigation, coordination, and cutting). Only fewer articles described models specific for peculiar operations. All studies showed a significant improvement of basic laparoscopic skills after training with BMs. Furthermore, their low costs make them easily available to most surgical trainees. Conclusions:: BMs should be developed by all surgical trainees during their training. Fields for future improvement regard endoscopy and complex laparoscopic operations for which ad hoc BMs are not available. © 2013 by Lippincott Williams and Wilkins.
TL;DR: For the treatment of EGC in Asia, LG has several advantages, including safety, less trauma, and faster recovery, which should be validated in western studies.
Abstract: Objective:To perform a meta-analysis comparing laparoscopic versus open gastrectomy (LG vs. OG) for early gastric cancer (EGC) in Asia.Methods:PubMed, Embase, CINAHL, AMED, the Cochrane database of Systematic Reviews, the Cochrane Controlled Trials Register, and the China National Knowledge Infrastr
TL;DR: Impact of anesthetics on IOP during laparoscopic surgery may change depending on the surgical position, and propofol may be more helpful in preventing ocular hypertension.
Abstract: Background:Pneumoperitoneum in the pelvic laparoscopic surgery induces a rise in the intraocular pressure (IOP). This study investigated whether IOP changes were different depending on the surgical position (Trendelenburg vs. reverse Trendelenburg) and the anesthetic drugs (propofol vs. desflurane).
TL;DR: It is demonstrated that laparoscopic appendectomy can be achieved through a single umbilical incision and a single working channel using conventional instruments and that this approach is successful, safe, economic, and esthetic.
Abstract: BACKGROUND This study aimed to evaluate the feasibility, safety, and cosmetic results of a novel technique, transumbilical single-incision laparoscopic appendectomy (TSILA), using a single working channel with conventional instruments. PATIENTS AND METHODS The study enrolled 84 consecutive patients undergoing laparoscopic appendectomy for acute appendicitis. To test the advantages of TSILA on the management of patients with acute appendicitis, a prospective randomized clinical trial was conducted. Surgical outcomes such as operation time, complication, and hospital stay of 42 patients undergoing TSILA were analyzed and compared with those of 42 patients undergoing classic 3-port appendectomy. All patients received a follow-up visit for 3 to 12 months. RESULTS The study consisted of 42 patients undergoing TSILA and 42 patients undergoing classic 3-port laparoscopic appendectomy with an average age of 34.1 and 34.9 years, respectively. The mean operative time of TSILA did not show any difference when compared with the classic procedure (84.8 vs. 77.9 min, P=0.271). No operative complications occurred in patients undergoing TSILA, whereas 2 patients undergoing the classic procedure showed incisional infection. The average postoperative hospital stay was 2.7 days in the TSILA group and 2.9 days in the classic procedure group with no difference (P=0.316). At the follow-up visit, no patient showed any evidence of incisional hernia. The transumbilical incisions were visible minimally, and the cosmetic scores given by patients undergoing TSILA was higher than that given by patients undergoing the classic procedure (4.5 vs. 3.9, P<0.001). CONCLUSIONS The results of the study demonstrate that laparoscopic appendectomy can be achieved through a single umbilical incision and a single working channel using conventional instruments and that this approach is successful, safe, economic, and esthetic.
TL;DR: PD seems to be the best treatment option for PIPA and compared with surgery it is associated with a higher success rate and lower hospital stay and mortality rate.
Abstract: Results: Primary and secondary abscess occurred in 20.6% and 79.4%, respectively. The leading cause of PIPA was spondylodiscitis (38%) and computed tomography was the preferred diagnostic modality (87%). Most common presentation was left unilateral abscess in 66% of patients and most frequent isolated bacteria were Staphylococcus aureus. Fifteen patients (44%) received antibiotics as initial treatment with an initial failure rate of 80%; 11 of 15 patients required a second treatment. Sixteen patients (47%) underwent percutaneous drainage (PD) as first line treatment with a success rate of 50%. However, success rate of PD, increased to 100% after 2 drainages. Three patients were surgically drained without success (0 of 3 patients). Compared with the rest of the population, PD showed a lower hospital stay (25 vs. 14 d, respectively, P = 0.08) whereas surgery had a higher mortality rate (8% vs. 22%, respectively, P = 0.03). Limitations: A single institutional retrospective study. Conclusions: Our series showed a higher proportion of unilateral and secondary abscess. Spondylodiscitis was the first cause of PIPA. PD seems to be the best treatment option for PIPA and compared with surgery it is associated with a higher success rate and lower hospital stay and mortality rate.
TL;DR: National Resident Training Programs should take into consideration the present quality of training and attempt to develop alternative methods of training for laparoscopic surgery, such as, the animal model laboratory.
Abstract: Background and Aim:Laparoscopic surgery is recognized as an established technique for several abdominal disorders. Aim of the present investigation was to assess the level of expertise of senior residents and to evaluate the role of the animal model on advanced laparoscopic training.Methods:Overall,
TL;DR: Outcome differed between patients undergoing right-sided and left-sided enucleations, the operative time being 178 versus 132 minutes, morbidity 64% versus 45%, and median hospital stay 26 versus 9 days, respectively, and laparoscopy seems to be of no use inright-sided procedures.
Abstract: Laparoscopic pancreatic enucleation is increasingly performed worldwide. Few small-sized series show encouraging results, especially after enucleations performed for lesions located in the left part of the pancreas. The outcome of laparoscopic pancreatic enucleations was retrospectively evaluated by the analysis of prospectively collected parameters. Results of right-sided (head/uncus) and left-sided (neck/body/tail) enucleations were compared. From 1997 to 2010, 25 patients underwent laparoscopic pancreatic enucleation. The conversion rate was 12%, mean operating time was 158 minutes, and mean blood loss was 106 mL. Morbidity was 56% and the rate of pancreatic fistula 32%. Outcome differed between patients undergoing right-sided and left-sided enucleations, the operative time being 178 versus 132 minutes, morbidity 64% versus 45%, and median hospital stay 26 versus 9 days, respectively. Pancreatic enucleation is feasible by laparoscopy, with a high success rate and no mortality but significant morbidity. Laparoscopy seems to be of no use in right-sided procedures. Pancreatic fistula is still the main cause of long-lasting morbidity.